Small increases in urbanicity in Uganda linked to cardiometabolic risk factors

Even in sub-Saharan Africa, the world's most rural region, urbanisation is associated with a higher prevalence of
lifestyle risk factors, according to a new study. Within Ugandan communities that lack paved roads and running water,
people living in villages with relatively more urban features were more likely to have risk factors for cardiometabolic
diseases.

"Our findings not only challenge the prevailing use of dichotomous urban-rural classification
systems in epidemiological studies, but also indicate that even small-scale increases in urbanicity levels across rural
environments are associated with a higher prevalence of unhealthy behaviours among rural residents." says
Johanna Riha, first author from the University of Cambridge.

Data collected in 2011 was used to examine associations between measures of urbanicity and lifestyle risk factors. The
study included 7,340 participants aged 13 years and older living in 25 villages in rural Uganda. They found that levels
of urbanicity varied markedly across the villages, ranging from those without educational facilities or electricity in
households, to villages with a public telephone and a dispensary.

" Even small-scale increases in urbanicity levels across rural environments are associated with a higher prevalence
of unhealthy behaviours among rural residents. "

Dr Johanna Riha

Despite the features of urbanisation being relatively modest, living in more urban villages was associated with
increased risks of cardiometabolic disease risk factors such as physical inactivity, low fruit and vegetable
consumption, and high body mass index, even after controlling for other factors such as socioeconomic status.

"Considering that over 533 million people live in rural areas across sub-Saharan Africa,"
says Manjinder Sandhu, senior author from the Wellcome Trust Sanger Institute and the University of Cambridge,
"any increase in cardiometabolic risk associated with the development process in these areas is
likely to have an impact on population health and healthcare services."

While the number of underweight people currently exceeds the number of overweight people in Uganda, the increase of
cardiometabolic diseases across sub-Saharan Africa is a cause for growing concern. By 2030 it is expected that 2.4
million deaths in sub-Saharan Africa will be due to cardiovascular disease and the prevalence of diabetes among adults
between 20 and 79 is expected to increase to 4.6 per cent of the population. It is hoped that studies like this will
inform early intervention strategies.

"A better understanding of these associations is crucial because modification of lifestyle risk
factors through changes in the physical environment, including local infrastructure, may provide a potential avenue for
primary prevention of cardiometabolic diseases in rural populations." says Professor Janet Seeley, senior author
from the Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS in Uganda and the London School
of Hygiene and Tropical Medicine.

Funding

Participating Centres

Please see the paper for a full list of participating centres.

The Department of Public Health and Primary Care, University of Cambridge

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The Medical Research Council/Uganda Virus Research Institute Uganda Research Unit on Aids

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The Wellcome Trust Sanger Institute

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The Wellcome Trust

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